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Observational cohort.Outcomes for acute musculoskeletal injuries are currently suboptimal, with an estimated 10% to 50% of injured individuals reporting persistent problems. An early risk-targeted intervention may hold value for improving outcomes.To describe the development and preliminary concurrent and longitudinal validation of the Traumatic Injuries Distress Scale (TIDS), a new tool intended to provide the magnitude and nature of risk for persistent problems following acute musculoskeletal injuries.Two hundred participants recruited from emergency medicine departments and rehabilitation clinics completed the TIDS and a battery of other self-reported questionnaires. A subcohort (n = 76) was followed at 1 week and at 12 weeks after the inciting event. Exploratory factor analysis and concurrent and longitudinal correlations were used to evaluate the ability of the TIDS to predict acute presentation and 12-week outcomes.Exploratory factor analysis revealed 3 factors explaining 62.8% of total scale variance. Concurrent and longitudinal associations with established clinical measures supported the nature of each subscale. Scores on the TIDS at baseline were significantly associated with variability in disability, pain intensity, satisfaction, anxiety, and depression at 12 weeks postinjury, with adequate accuracy to endorse its use as part of a broader screening protocol. Limitations to interpretation are discussed.We present the initial psychometric properties of a new measure of acute posttraumatic distress following musculoskeletal injury. The subscales may be useful as stratification variables in subsequent investigations of clinical interventions.